Journal of Medicine and Medical Sciences Vol. 4(2) pp. 50-55, February 2013
Available online http://www.interesjournals.org/JMMS
Copyright © 2013 International Research Journals
Full Length Research Paper
Assessment of Osteoporosis KAP among women in
Assir region, Saudi Arabia
Amani A Osman
Assistant Prof., Consultant Reproductive Health, Family and Community Medicine Department, College of Medicine,
King Khalid University, Abha, 61421 Abha, P.O. 641, Saudi Arabia
E-mail: amanieldosh@gmail.com
Abstract
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis, the bone
mineral density (BMD) is reduced. Globally osteoporosis constitutes a public health problem.
Researchers have been curious about the true estimate of osteoporosis prevalence in the Kingdom of
Saudi Arabia. The current study was designed to assess the extent of knowledge attitude and practice
(KAP) about the disease, among Saudi women. Therefore, we can decrease the prevalence of the
disease. The study was a cross-sectional in design. A valid and reliable questionnaire (OAKT
questionnaire) used to asses (KAP) of osteoporosis among women attending health centers in Abha
city in Assir region, Saudi Arabia, during the period of January 2012 to June 2012 Collection of data
done by personal interview, after explain to all participant the aim of the study, and take their consent.
Evaluation done by giving each correct answer 1 and for wrong and don’t know score of 0, the average
baslin osteoporosis cap was core of 8.8 out of 20. Mean ages of the women were 35.7 years. Illiteracy
was 42% and single women around one third of the participant Knowledge score was 3.3 which is very
poor. Knowledge and attitude and practice among Saudi women were very poor and a lot of health
education need to be taken.
Keywords: Osteoporosis, assessment, knowledge, attitude, practice, Saudi Arabia.
INTRODUCTION
Osteoporosis is a disease of bones that leads to fragility
and increased risk of fracture. In osteoporosis, the bone
mineral density (BMD) is reduced, bone microarchitecture deteriorates, and the amount and variety of
proteins in bone are altered. Osteoporosis is defined by
the World Health Organization (WHO) as a bone mineral
density of 2.5 standard deviations or more below the
mean peak bone mass (average of young, healthy adults)
as measured by dual-energy X-ray absorptiometry; The
disease may be classified as primary type 1, primary type
2, or secondary. The form of osteoporosis most common
in women after menopause is referred to as primary type
1 or postmenopausal osteoporosis. Primary type 2
osteoporosis or senile osteoporosis occurs after age 75
and is seen in both females and males at a ratio of 2:1.
Where secondary cause related to certain diseases or
usage of specific drugs (Kim DH, 2006).
Osteoporosis is one of the diseases which affect
an important sector of the population and therefore have
serious impact on the community.
Researchers have adopted different questionnaires
to evaluate knowledge, attitude and practice (KAP)
among the participants involved in studies. OKTA
questionnaire which we used in this study, includes 20
item instrument with true, false and don't know responses
to evaluate information about the disease content,
prevention and management aspects. Psychomotor data
are valuable to be gained which reflect, social and beliefs
in specific community that can affect the disease
distribution and management (Tanprasertkul et al., 2010).
There is evidence suggesting that osteoporosis
knowledge is one contributor to osteoporosis preventive
behavior, though this is not a clear-cut relationship.
Cross-sectional studies have varied in whether they have
found an association between levels of osteoporosis
knowledge and osteoporosis preventive behaviors
(kasper MJ and JP, 2001).
Osman 51
In Saudi Arabia the magnitude of osteoporosis problem is
not yet clearly weighed. In previous study; osteoporosis
was more common among Type 2 diabetic
postmenopausal Saudi females than the non-diabetics.
Since both groups were postmenopausal, having equal
percentage of Vitamin D deficiency, multi-parity, non
exposure to sun, lack of exercise and negligible milk
intake, this concluded that the low BMD can be attributed
to DM in the absence of other causes of osteoporosis (AlMaatouq MA, 2004).
A study on osteoporosis in postmenopausal Saudi
women using dual x-ray bone densitometry, concluded
that bone densitometry should be used to assess the
severity of bone loss, identify those who need therapy
and for follow up and early diagnosis of those with
osteopenia in order to institute proper therapy and avoid
future osteoporosis (El-Desouki MI, 2003 , El-Desouki MI,
2005).
Osteoporosis risks can be reduced with lifestyle
changes and sometimes medication; in people with
osteoporosis, treatment may involve both. Lifestyle
change includes diet and exercise, and preventing falls.
Medication includes calcium, vitamin D, bisphosphonates
and several others. Fall-prevention advice includes
exercise to tone deambulatory muscles, proprioceptionimprovement exercises; equilibrium therapies may be
included. Exercise with its anabolic effect, may at the
same time stop or reverse osteoporosis. Osteoporosis is
a component of the frailty syndrome.
This study aimed to assess the level of accuracy of
the estimate of HIV prevalence with the view to knowing
the direction of the estimate. It also strives to identify
factors that are predictors of being infected with HIV virus
in Nigeria. These objectives would provide information on
how to strengthen HIV estimate and create an avenue for
the implementation of various evaluations of HIV
programmes in Nigeria and other countries with similar
population structure. This will assist in actualization of the
sub-theme of Millennium Development Goals to combat
HIV/AIDS in Nigeria.
MATERIAL AND METHODS
The study area
The study was a cross-sectional in design. It was
conducted in 5 health centers in Abha city ( Almanhal,
Shamsan, Alnmus, Al mansak, Al Azizia ) in Assir region,
South West of Saudi Arabia, during the period of January
2012 to June 2012 .
Sampling procedure and Data collection
Data collected to assess Knowledge attitude and practice
(KAP) about osteoporosis among Saudi women attending
5 health centers for deferent reasons. Their age were 15
years and above. The investigation procedures followed
were in accordance with the ethical standards of the
responsible committee on human experimentation
(Research Center For Medical Colleges, King Khalid
University) and with the Helsinki Declaration of 1975, as
revised in 2000. Informed consent was obtained from the
participants after clear explanation of this study. Primary
data were collected by personal interview using wellstructured questionnaire. A valid and reliable
questionnaire OAKT questionnaire used to asses (KAP)
of osteoporosis among women (Tania M Winzenberg*1
and 2003). It included 20 questions which is sociodemographic characteristics, 12 questions about
knowledge, question 13 to 16 about attitude towards the
disease and last 4 questions about perception and
practice towards prevention of osteoporosis.
Evaluation done by giving each correct answer 1 and for
wrong and don’t know score of 0, the average baseline
osteoporosis (KAP) was score of 8.8 out of 20.
Data analysis
Data were analyzed using SPSS.
RESULTS
Socio-demographic characteristics of women
Overall, a total of 119 women attending 5 health centers
in Abha city ( Almanhal, Shamsan, Alnmus, Al mansak,
Al Azizia ), their age above 15 years, were involved in the
study . The mean ages for the participants were
35.7years. Age group was shown in table 1. There was a
wide variation of educational level among participants but
all those above 45 years old (42.8% ) were illiterate.
Marital status: around 60% of the participants were
married.
The evaluation of knowledge question was 3.3 out of
12, which is very low according to the score of OKTA,
and that means knowledge about the disease was very
poor among study group. The lowest score was on the
question about that the disease is common in men;
almost 90% did not know the right answer. They agreed
that this disease is a disease of men. The highest score
among questions of knowledge was that question about
the increase chance of fracture. Regarding attitude and
practice to prevent the disease. The total score was 3.1,
again it is very poor. Especially among young females
(15-19yrs) which is very serious. Almost 90% of this
group did not know the right answer. Figure 1 and 2
show response to food practice and individual practice.
The majority of patients (57.1%) had limited activity
and 71.2% had no outdoor work at all or doing exercise.
52 J. Med. Med. Sci.
Table 1. AGE Distribution of the participants
Age group
15-25Yrs
26-35Yrs
46-55Yrs
56Yrs and above
Total
Frequency
27
35
38
19
119
Percent %
22.6
29.6
31.9
15.9
100.0
Table 2. Cross tabulation between response of age towards the effect of exercise and pain
Count
PAIN
TRUE
AGE
FALSE
Total
AGE
DON'T
KNOW
Total
AGE
EXERCISE
TRUE FALSE
15-25YRS
23
26-35YRS
22
26-35YRS
14
46-55YRS
22
56YRS AND ABOVE
15
36
15
46-55YRS
-
Total
Figure 1. Provide legend
Figure 2. Provide legend
Total
DONOT KNOW
10
18
29
17
33
18
51
14
22
15
51
17
17
17
Osman 53
None of them had a regular sport activity. Table 2 show
the response of different age group towards the
knowledge of effect of exercise and occurrence of pain as
symptoms of osteoporosis.
DISCUSSION
Osteoporosis (OP) is a major, highly prevalent health
problem which under estimated in many countries. The
osteoporosis-related fractures account for high morbidity
and mortality. Therefore, prevention and early detection
of osteoporosis should strive to substantially reduce this
risk of complications. Few studies have been conducted
in Saudi Arabia (Addar et al., 2005). One of these studies
done to correlate age at menopause and osteoporosis
among Saudi women. All menopausal women share in
the study had bone mineral density at King Khalid
University Hospital, Riyadh, Saudi Arabia, between 1999
to 2003. Correspondence and logistic regression analysis
were conducted to identify variables that were positively
associated with age of menopause. It reveals that age of
menopause among Saudi women is lower than in
Western countries but similar to other Arabic countries. In
addition to cultural differences genetics play a role in
determining the age of menopause and the development
of osteoporosis. The diagnosis of osteoporosis always
shows a challenge but few risk factors have been
detected in many studies (Geller and Derman, 2001,
Gemalmaz and Oge, 2008).
This study showed that the majority of patients
(71.2%) had no outdoor work at all or doing exercise.
None of them had a regular sport activity. This result was
similar to a study done in Turkey, include total of 107
female patients (mean age 74 years; range 63 to 100
years) who experienced hip fractures after the age of 60
years were included in a previous study using a
questionnaire to determine their physical and social
characteristics, medical conditions , and nutritional status.
In addition, the types of fractures were determined by
radiographs.
The outcomes enclosed; the mean body mass index
was 23 kg/m2. The Forty-four patients (41.1%) were
illiterate, and 31 patients (29%) were only literate or could
finish primary school. A history of smoking was found in
29.9% for a mean duration of 30.7 years. The majority of
patients (67.3%) had limited activity and 63.6% had no
outdoor work at all. None of them had a regular sport
activity. Only two patients (1.9%) received inadequate
and short-term postmenopausal therapy. The mean daily
milk consumption was less than a glass (125-150 ml).
Calcium supplements were used in only 5.6%. A history
of previous fractures (hip, vertebra, distal radius) was
detected in 9.3%. The most common coexistent diseases
were hypertension (50%) and diabetes (29%). None of
the patients had bone mineral density measurements.
The study showed that, despite the high incidence of risk
factors for osteoporosis, few patients received medical
care for the diagnosis and treatment of osteoporosis, and
that preventive health care measures were not available
for this patient group (Unay et al., 2005) .
Another study conducted in Spain (Luz Rentero et al.,
2008); 4,960 women, at 96 Primary Care centers.
Demographic and anthropometrical data, as well as
information regarding risk factors for OP were collected
using a questionnaire. The prevalence rates for the major
osteoporosis risk factors were: low calcium intake, 43%;
benzodiazepine use, 35.1%, and height loss, 30.1%.
Other relatively prevalent factors include: having suffered
at least one fall during the preceding year; positive family
history of falls (particularly on the mother's side),
smoking, kyphosis, presence of any disease affecting
bone metabolism, personal history of falls, and inability to
rise from a chair without using one's arms. The least
frequent factors were weight loss of greater than 10%
over the preceding 10 years and problems in sensory
perception that affect patient's ability to walk.
The study concluded that; the main risk factors for
osteoporosis in women 50-65 years of age are low
calcium intake, use of benzodiazepines, and observed
loss of height. These results may help physicians to
identify groups at risk for OP and fractures at early stages
and consequently, optimize prevention and early
diagnosis of osteoporosis in postmenopausal women.
Many factors such as social and demographic, have
been reported to affect the disease distribution (Miura et
al., 2010).
The prevalence of this disease is affected by the poor
level of women knowledge, attitude and practice (Terrio
and Auld, 2002, Pande et al., 2005). From this study the
age of participants in relation to their knowledge, of both
elder women (>50 years) and younger ones (15 -19
years) were very poor in their knowledge this is similar to
a study done in Pakistan; the knowledge on osteoporosis
in younger women was found to be very poor compared
to relatively older females. However, women belonging to
higher socioeconomic status and better education had
slightly more knowledge about osteoporosis compared to
those with a low education level, regardless of age (Riaz
et al., 2008).
A sample of 217 women, 13 to 76 years of age, who
were attending 1 of 2 health care facilities in Da Nang,
Vietnam, between November and December 2009 were
involved in a study in which a questionnaire completed
assessing their awareness of osteoporosis and
measuring their knowledge using a 30-item instrument
reflecting 9 knowledge domains risk factors, diagnosis
and prognosis. The results revealed, A majority (81.6%)
of the women had heard of osteoporosis. Awareness was
associated with education, working in health care, and
having a family member with osteoporosis. On average,
Vietnamese women answered 49% of the knowledge
54 J. Med. Med. Sci.
questions correctly; scores ranged from 0 to 26 questions
correct out of 30 (mean = 14.71 ± 5.2, median = 15).
Mean knowledge scores were higher among those
reporting a family member with osteoporosis, nurses (vs
other vocations), and women with a high school
education or greater (relative to those who had not
completed high school). More than 90% of the women
expressed interest in a prevention and treatment
program. The study concluded that, Vietnamese women
may have heard of osteoporosis, yet they would benefit
from education targeting prevention and treatment of the
disease (Nguyen et al., 2011).
In order to measure the knowledge, attitude and
practice, this should depend on the design of a valid and
reliable questionnaire to measure osteoporosis
knowledge in women such as the Osteoporosis
Knowledge Assessment Tool (OKAT). In previous study;
a questionnaire was used to collect data to explore the
knowledge, attitude, and activity regarding osteoporosis
of middle-aged and elderly women in Taipei, Taiwan, It
was delivered by way of a face-to-face interview. The
findings indicated that the mean score on a “knowledge”
scale was 15.37 (SD = 11.37; total scores ranging from 0
to 44). Among six dimensions of knowledge, the highest
score was noted for “incidence of osteoporosis "; and the
lowest score was for “diagnosis and treatment ". For
attitudes, the highest score was noted for “perceived
efficacy of actions "; whereas the lowest score was for
"perceived susceptibility ". For preventive activity, women
revealed extremely low percentages in “checking bone
mass density" (2.7%) and "reading materials relating to
osteoporosis" (7.8%). Multiple and stepwise regression
analyses on preventive activity indicated that six
variables (knowledge, previous physical examination
history, perceived severity of osteoporosis, perceived
value of early detection and treatment, attainment of a
senior high school degree or over, and health status)
could be singled out as significant factors and accounted
for 36.1% of the variance. These findings reveal that
broader health educational programs and health services
regarding osteoporosis are necessary for Taiwanese
women (Yu and Huang, 2003).
Overall the management strategies of osteoporosis
has to be planned depending on community beliefs and
psychometric aspects (Cadarette et al., 2007). In
previous study comprised 132 patients women aged
more than 50 years old whose diagnosed with
osteoporosis; the management profile involved (140
fractures) included in the study had a mean age of 73.8
years. Fracture sites in decreasing order of frequency
were the wrist (29%), the hip (28%), the ankle (19%), the
pelvis, the humerus, and the leg.
In other study, data on management by the primarycare physician were available for 106 patients. Fifty
patients (50/106, 47%) were given a diagnosis of
osteoporosis by their primary-care physician and 38
(38/106, 35%) received medications for osteoporosis
(Briancon et al., 2004).
Almost all osteoporosis studies conducted were
measuring the knowledge, attitude and practice of
participants. The final usage of these knowledge and
practice should affect the individual attitude towards any
health problem (Unson et al., 2001, von Hurst and
Wham, 2007).
CONCLUSION
In conclusion, Osteoporosis knowledge was low among
Saudi ladies, thus attitude and practices also low towards
this disease. This finding is similar to other studies done
in the kingdom in different cities, but there was no
response. So this will enhance health authorities to
create program to upraise the awareness of the
community for this important disease, especially at
primary health care levels and at school.
ACKNOWLEDGMENTS
Great thanks to the staff of Family and Community
Medicine department, King Khalid University, Abha and
staff of all five primary health care centers in Abha, Assir
region Kingdom of Saudi Arabia.
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